Oral cleaning instruments, oral suctioning instruments, and suction catheters are commonly used in health care patients with respiratory distress, critical illness, chronic illness, terminal illness, weakness, paralysis, or any patient requiring breathing support from a ventilator.
To perform oral cleaning, most caregivers use foam swabs with various antiseptic solutions to clean and moisten a patient's mouth. Oral suctioning is commonly performed by inserting a rigid plastic tube, often called a Yankauer suction, into a patient's mouth to suction out saliva and mucus. The purpose of oral cleaning and oral suctioning is to remove bacteria that build up in the mouth of patients who are unable to perform oral care, such as brushing their teeth. Various studies have shown that the buildup of bacteria in patients who are unable to perform oral care increases their risk of the nosocomial pneumonias, hospital acquired pneumonia (“HAP”) and ventilator associated pneumonia (“VAP”), due to the aspiration of saliva and secretions with high levels of bacteria.
Tracheal and pharyngeal suctioning is commonly performed to suction out secretions when a non-intubated patient is too weak to cough up secretions on their own. Sometimes pharyngeal suctioning is performed in an intubated or tracheostomy patient to reach secretions that have passed down to the tracheal and pharyngeal area. Tracheal and pharyngeal suctioning may be performed via either nasal route suctioning or oral route suctioning. In either case, a tracheal suction catheter is used, which typically is a soft, pliable plastic or rubber tube. In the case of nasotracheal suctioning, the tracheal suction catheter is inserted into the naris and continues down the trachea. Once the tracheal suction catheter reaches the trachea, the unwanted secretions are suctioned out. The nasotracheal or nasopharyngeal suctioning method can cause nasal trauma, pain, and bleeding. In addition, the suction catheter also has a tendency to coil in the back of the throat and may trigger the patient's gag reflex.
Typically, orotracheal or oropharyngeal suctioning is attempted in patients with increased coagulation times, nasal fracture, deviated septum, or if coiling continues to occur in the nasotracheal approach. To perform orotracheal suctioning, the tracheal suction catheter is inserted into the mouth and continues down the trachea. Once the tracheal suction catheter reaches the trachea, the unwanted secretions are suctioned out. Similar to the nasotracheal suctioning method, the suction catheter has a tendency to coil in the back of the throat and may trigger the patient's gag reflex.
Patients are usually in an altered mental state from sedation, confusion, or being frightened and sometimes do not cooperate for oral cleaning, oral suctioning, and tracheal and pharyngeal suctioning. Patients sometimes bite down on the cleaning and suctioning instruments, which can stop the oral cleaning, oral suctioning, and tracheal and pharyngeal suctioning processes, and sometimes break a piece of the instrument off in the patient's mouth or even bite caregivers' fingers. Other problems that exist include instrument insertion trauma to the nose or mouth and the spread of bacteria from the mouth to the lungs during tracheal suctioning.